The association between fragmented QRS (fQRS) and autonomic nervous dysfunction, and major adverse cardiovascular events (MACE) is not fully clear in patients with acute myocardial infarction (AMI). This study aimed to observe whether combined assessment with fQRS and cardiac autonomic nervous function could enhance the predicting efficacy on outcome in AMI patients. A total of 153 consecutive hospitalized AMI patients were included in this retrospective study. Patients were divided into non-fQRS (nfQRS) group and fQRS group according to 12-lead electrocardiogram, into sHRV [severely depressed heart rate variability (HRV): standard deviation of NN intervals (SDNN) < 100 ms and very low frequency (VLF) < 26.7 ms] group and nsHRV (non-severely depressed HRV) group according to 24 h Holter monitoring, and into non-MACE (nMACE) group and MACE group according to 12 months’ follow-up results. The incidence of sHRV was significantly higher in the fQRS group than in the nfQRS group (71.9 vs. 39.3%, p < 0.05). The incidences of MACE were 7.4, 22.2, 25.7 and 56.5%, respectively, in nsHRV + nfQRS group, nsHRV + fQRS group, sHRV + nfQRS group and sHRV + fQRS group (p < 0.05). Multivariable Cox regression analysis showed that patients in the sHRV + fQRS group had a sixfold higher risk of MACE compared to patients in the nsHRV + nfQRS group (HR = 6.228, 95% CI 1.849–20.984, p = 0.003). The predicting sensitivity and specificity on MACE were 81.4 and 58.2% by sHRV, 69.8 and 69.1% by fQRS in these AMI patients. The specificity (81.8%) was the highest with the combination of sHRV and fQRS. Adding sHRV and fQRS to clinical data offered incremental prognostic value. Present results indicate that fQRS is closely related to sHRV, suggesting significant impairment of sympathetic nerve function in AMI patients with fQRS. Combined assessment with fQRS and sHRV enhances the predicting efficacy on outcome in AMI patients.

在急性心肌梗死 (AMI) 患者中，碎片 QRS (fQRS) 与自主神经功能障碍以及主要不良心血管事件 (MACE) 之间的关系尚不完全清楚。本研究旨在观察结合 fQRS 和心脏自主神经功能的评估是否可以提高对 AMI 患者预后的预测效果。这项回顾性研究共纳入了 153 名连续住院的 AMI 患者。根据12导联心电图将患者分为非fQRS（nfQRS）组和fQRS组，分为sHRV[严重抑制心率变异性（HRV）：NN间期标准差（SDNN）<100 ms和极低频（VLF） ) < 26.7 ms] 组和 nsHRV（非严重抑郁 HRV）组根据 24 小时动态心电图监测，并根据12个月的随访结果分为非MACE（nMACE）组和MACE组。fQRS 组的 sHRV 发生率显着高于 nfQRS 组（71.9% vs. 39.3%，p  < 0.05)。nsHRV+nfQRS组、nsHRV+fQRS组、sHRV+nfQRS组和sHRV+fQRS组MACE发生率分别为7.4%、22.2%、25.7%和56.5%（p  < 0.05）。多变量 Cox 回归分析显示，与 nsHRV + nfQRS 组患者相比，sHRV + fQRS 组患者的 MACE 风险高出 6 倍（HR = 6.228, 95% CI 1.849–20.984, p = 0.003)。在这些 AMI 患者中，sHRV 预测 MACE 的敏感性和特异性分别为 81.4% 和 58.2%，fQRS 预测为 69.8% 和 69.1%。特异性 (81.8%) 以 sHRV 和 fQRS 的组合最高。将 sHRV 和 fQRS 添加到临床数据中提供了增加的预后价值。目前的研究结果表明，fQR​​S 与 sHRV 密切相关，表明 fQRS 的 AMI 患者的交感神经功能显着受损。与 fQRS 和 sHRV 联合评估增强了对 AMI 患者预后的预测效果。